JP3232938U - Tow device and tow ring for tow device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a traction device in the medical machine field and a traction ring for the traction device. SOLUTION: The traction device includes a clamp portion and a traction portion, the traction portion includes a closed traction structure 11 made of an elastic material, the clamp portion includes a clamp main body 23 and a clamp arm 24, and the clamp main body. Can pass through the endoscopic biopsy channel and the clamp arm can clamp a closed traction structure. Further, the traction ring for the traction device is either one closed traction structure or several closed traction structures are connected, and the traction ring is made of elastic material. [Selection diagram] Fig. 2

Description

The present invention relates to a traction device and a traction ring for a traction device in the medical machine field, and in particular, it has good elasticity, does not require an external force, and can realize traction for a cut lesion only by the elasticity of the traction part, and can provide a surgical operation field of view. The present invention relates to a traction device that facilitates further pinching of a wound surface because it can be pulled to shrink a large wound surface while being sufficiently exposed.

EMR (endoscopic mucosal regression, EMR) treatment for early gastric cancer was initially used clinically in Japan, and gastrectomy was the only treatment for early gastric cancer before it was introduced in Japan. However, at present, the treatment method is widely applied. Endoscopic submucosal dissection (ESD) means endoscopically removing the mucosa directly from the submucosa using an improved needle knife, mucosal resection EMR It has evolved from. Due to its high complete resection rate and high safety, it has expanded the indications for early gastrointestinal cancer and other tumor resections and is gradually becoming a widely accepted minimally invasive surgical treatment method.

Both ESD and EMR have made it possible to remove lesions using a single normal single-channel endoscope, eliminating the pain of open surgery and eliminating the need for organ resection. The disadvantages of EMR are that large lesions cannot be resected at once with the technique, it is difficult to perform detailed pathological analysis on the excised small mass specimen, the stage of the tumor is unclear, and there is a high risk of tumor recurrence. That is. On the other hand, ESD has the following four points as compared with open surgery and conventional endoscopic treatment methods such as EMR. 1. 1. The wound is small. 2. Patients can receive multiple treatments at multiple sites. 3. 3. The doctor will obtain a complete histopathological specimen for analysis. 4. In order to reduce the probability of recurrence, the excision rate for tumors with a large area and irregular morphology, or tumors with combined ulcers and scars is 96% or more.

However, ESD has a longer operation time, a higher risk, and is more difficult to operate than EMR. The operation time of EMR is about 20 minutes, but the operation time of most ESD is 60 to 90 minutes, and it is large because of complications such as bleeding, perforation, stenosis, and postoperative infection. It is disadvantageous for widespread use and application. In EMR surgery, bleeding is less likely to occur, but in the process of operating ESD, if a little care is taken, the visual field is covered with blood, so it is necessary to continue to stop bleeding and flush the visual field. The main steps of ESD surgery are marking, submucosal injection, marginal incision, exfoliation, and wound surface treatment. Repeated submucosal injections usually provide a limited surgical field of view for subsequent detachment operations, but repeated injections provide surgical time for some lesions in areas where ESD treatment is difficult. It becomes longer and increases the risk of bleeding and perforation. Another simple solution is to try to adjust the patient's position according to the direction of gravity so that the detached surface has ideal tension and a working field of view, but some surgery (upper digestion). In (with respect to the tube), the patient's selectable positions are limited, which limits its effectiveness. Therefore, how to provide a good "surgical field of view" during surgery is the key to solving the above problems. National scholars are striving for ways to provide a good field of view for surgery and to achieve safe and accurate cutting and peeling operations.

Inspired by surgical tension techniques, various endoscopically assisted traction techniques were born. Depending on the part that is the source of traction force, it can be roughly divided into internal traction and extracorporeal traction. Depending on the configuration of the traction device, it can be divided into dental floss traction, metal clip and suture thread connection traction technology, metal clip and elastic ring connection traction technology, SO metal clip traction technology, magnetic anchor technology and the like.

Recently, in one sentence about gastrointestinal endoscopy, in the discussion part, dental floss is a relatively good auxiliary ESD, but there is a possibility of tissue damage, and it is necessary to pay attention to this point when using it, and It was pointed out that the direction of dental floss traction is fixed and the traction end is outside the body, so the direction of dental floss must be parallel to the endoscope and the traction direction is restricted.

The metal clip and suture binding traction technique does not allow the suture to continue to pull and cut because the suture is not elastic and the suture can lose its effectiveness after cutting a portion of the lesion. The process does not go smoothly.

Metallic clip and elastic ring coupling traction technology is difficult to operate because of the limited size of the elastic ring, the need to tie the O-ring to the clip with sutures, and the need to use a dedicated sheath. It is complicated and inconvenient for the user.

The SO metal clip traction technique is an in-vivo traction technique designed on the basis of springs, metal clips and nylon rings. The method evolved from the metal clip and elastic ring coupling traction method, which attempts to obtain greater elasticity by using a spring instead of an elastic ring to achieve large early superficial colorectal cancer. Adapted to ESD resection. However, after cutting, there is no tension in the spring, the volume occupied by the spring is large, and it is not possible to enter the biopsy channel of the endoscope. After sandwiching with a metal clip extending from the inspection channel, it is subsequently sent into the body, and in the process of reaching the target position, it is exposed at the distal end of the biopsy channel, so it is easy to hurt the human body. Use is limited.

Magnetic anchor traction technology requires special equipment such as equipping a formal telescopic arm and continuously changes the direction outside the body to traction, so the operation is complicated and if there are many magnets during the surgical process, it will be operated. The field of vision is obstructed.

The traction device of the present invention is composed of a clamp portion and a traction portion, and the traction portion is elastically deformed and stretched depending on its own elasticity, and provides a traction force in the body to pull the lesion. The surgical operation field of view can be sufficiently exposed. Since it is not necessary to provide external force, it is possible to perform traction on mucous membranes, tissues and organs without being restricted by the anatomical position and the size of the lumen of the digestive tract, and the position where ESD surgery operation is particularly difficult. By applying to, doctors can perform mucosal dissection surgery in a more intuitive and visual situation, making the surgery safer and easier, significantly reducing surgery time and patient pain. It can be applied to the exfoliation of large-area lesions.

Commonly used gastrointestinal endoscopes include biopsy channels, objective lenses, LED light sources, water supply channels, drainage channels, etc., where biopsy channels are used to feed clamps and tractions. Be done.

A traction device, wherein the traction device includes a clamp portion and a traction portion, the traction portion includes a closed traction structure made of an elastic material, and the clamp portion can pass through a biopsy channel of an endoscope. It includes a clamp body and a clamp arm capable of sandwiching the closed traction structure.

Preferably, the closed traction structure is made of silicone rubber or thermoplastic elastomer.

Preferably, the closed traction structure is one or more.

Preferably, the closed traction structure can be circular, triangular, rhombic, square or the like.

An elastic structure may be connected between two or more closed traction structures, preferably an elastic structure such as an elastic linear structure or an elastic ring.

The movement of the clamp body can cause elastic deformation of the closed traction structure.

A traction ring for a traction device, wherein the traction ring is either one closed traction structure or several closed traction structures are connected, the traction ring is made of elastic material and has a closed traction structure. An elastic structure is connected between.

Preferably, the elastic structure is a structure such as an elastic linear structure or an elastic ring.

Preferably, the closed traction structure can be circular, triangular, rhombic, square or the like.

In the actual operating process, the lesion location is marked along the circumference with an electrotome, and the lesion tissue is raised by injecting fluid through the electrotome or an external syringe, resulting in a liquid cushion under the mucous membrane, ie. Form a "water pad". The "water pad" creates an effective isolation between the muscle layer and the lesioned tissue, effectively blocks heat conduction, clears the surgical field of view, and causes the blood vessels to be compressed by the water pad. It is closed and the risk of bleeding is significantly reduced. After completing the pre-peeling of the mucous membrane in the body, the electrotome is pulled out, the first clamp portion of the traction device is opened, one end of the closed traction structure is clamped by the clamp arm of the first clamp portion, and the first clamp portion is used. And the closed traction structure together are placed in the biopsy channel of the endoscope, and after reaching the distal end of the biopsy channel, under observation with the eyepiece of the endoscope, the clamp arm of the first clamp portion. To sandwich one end of the pre-peeled tissue and one end of the closed traction structure. At this time, subsequently, the proximal end and the distal end of the clamp body of the first clamp portion are separated, and the distal end of the clamp body of the first clamp portion and the closed traction structure remain in the body. Continue the previous operation, insert the second clamp into the biopsy channel of the endoscope, reach the distal end of the biopsy channel, and then under observation with the eyepiece of the endoscope, the second The clamp arm of the clamp part is expanded, passes through the other end of the closed traction structure, and is pulled to the other end of the pre-peeled tissue with the assistance of an endoscope to remove the edge of the pre-peeled tissue. Clamp. Subsequently, the proximal end and the distal end of the clamp body of the second clamp portion are separated, and the distal end of the clamp body of the second clamp portion and the closed traction structure remain in the body. Due to the elasticity of the closed traction structure, during the surgical amputation process, the amputated lesions abduct due to the elastic action of the traction, and as the surgical amputation operation progresses, the amputated lesions are completely removed. It continues to be pulled and gradually separated from the muscle layer until it is pulled up, completing the separation of the lesion completely. By such a method, the lesion is abducted while being cut, the surgical field of view is widened, and the blood vessel under the cut target can be found under the direct view of the endoscope, so that bleeding is prevented and the surgical operation can be performed. It will be more convenient and safer and the operation time will be shortened. If the lesion is too large, the clamp and closed traction structures may be further increased to pull the larger area of the lesion completely, or the elastic deformation of the entire traction. The traction portion including the elastic linear structure may be selected so as to increase the range of.

In the traction device of the present invention, the clamp portion and the traction portion are integrally associated with each other, the traction portion has elasticity, and the traction portion can provide an acting force in the body depending on its own stretching. Since it is not necessary to provide an external force, it is not limited by the anatomical position and the size of the lumen of the gastrointestinal tract, and is particularly suitable for use in a position where ESD surgical operation is difficult. The elasticity of the material is good, the size of the pulling range can be adjusted according to the demand, and the cutting demand of lesions of different sizes can be met, so the scope of ESD surgery can be expanded, the speed of ESD surgery can be increased, and the operation time can be increased. To save.

If it is discovered that the traction is loose during the actual use of the product, add some clamps, sandwich the closed traction structure, pull in the other direction, then clamp and more. It can form a rectangular structure and continue to provide tensile force to widen the operating field of view. By doing this until the tissue is completely separated, the separation process is smooth.

It is sectional drawing and the front view of the traction part which is two ring-shaped closed traction structures. It is a schematic diagram of the traction part which is three ring-shaped closed traction structures. It is a schematic diagram of the traction part which is four ring-shaped closed traction structures. It is sectional drawing and the front view of the triangular closed traction structure. It is a schematic diagram in which a clamp part and a traction part cooperate with each other. It is a schematic diagram which feeds a clamp part and a traction part into a biopsy channel of an endoscope. It is a schematic diagram which sandwiches a lesion with a first clamp part and a ring-shaped closed traction structure under the guidance of an endoscope. It is a schematic diagram which sandwiches a lesion with a second clamp part and a ring-shaped closed traction structure under the guidance of an endoscope. It is a schematic diagram that a clamp part and a ring-shaped closed traction structure cooperate with each other to separate a lesion. It is a schematic diagram that a traction device separates a lesion when a space is relatively small. It is a schematic diagram in which an elastic linear structure is connected between a ring-shaped closed traction structure. It is a schematic diagram which reduces the wound surface of a lesion by a traction device when the wound surface of a lesion is relatively large. It is a schematic diagram which reduces the wound surface of a lesion by a traction device when the wound surface of a lesion is relatively large. It is a schematic diagram which reduces the wound surface of a lesion by a traction device when the wound surface of a lesion is relatively large.

In order to clarify the purpose, technical solution and advantages of the present invention, the present invention will be described in more detail with reference to the drawings and examples. It should be noted that the specific examples described in the present specification are merely for interpreting the present invention and do not limit the present invention.

Hereinafter, the end closer to the operator of the endoscope is defined as the proximal end, and the end farther from the operator is defined as the distal end.

1A-1D and 8 are schematic views of different types of closed traction structures. FIG. 1A is a schematic view in which the traction portion 1 includes two ring-shaped closed traction structures, and the two ring-shaped structures are closed-connected to form the traction portion 1 of the closed traction structure. 1B and 1C are schematic views of a traction portion 1 having three ring-shaped closed traction structures and four ring-shaped closed traction structures. FIG. 1D is a cross-sectional view and a front view of a triangular closed traction structure. As shown in FIG. 8, the traction portion 1 may have an elastic linear structure attached in the closed traction structure, and both the closed traction structure and the elastic linear structure can generate elastic deformation, and the lesion 5 is formed. It should be completely separated from the mucosal layer 6 and such a structure is particularly suitable when the lesion 5 is relatively large. The closed traction structure 11 may be made of an elastic material, preferably the elastic material is a silicone rubber or a thermoplastic elastomer, and the closed traction structure may be one or two or more. In the actual use process, different types of traction portions may be selected and pulled / separated based on different sizes of lesions, and can be applied to mucous membranes, tissues, organs and the like.

Hereinafter, the process of using the traction device in the present invention for traction / separation of mucous membranes will be described by taking the case where the traction portion is composed of only a closed traction structure as an example. In the actual operating process, an electrotome is inserted near the lesion tissue through the biopsy channel of the endoscope, marking around the lesion location, and after the marking is complete, the electrotom or external syringe. By injecting fluid through the mucosa, the lesion tissue is raised to form a fluid cushion, or "water pad," under the mucosa. As shown in FIGS. 2 to 6, FIG. 2 is a schematic view in which the clamp portion 2 and the traction portion 1 cooperate with each other, and the clamp portion 2 includes the clamp main bodies 23 and 25 and the clamp arms 24 and 26. After completing the exfoliation of the mucous membrane in the body in advance, the electrotome is pulled out, the clamp arm 24 of the clamp portion 2 of the traction device is expanded, and one end of the closed traction structure 11 of the traction portion 1 is sandwiched between the clamp arms 24. As shown in FIGS. 3 and 4, the first clamp portion 21 and the closed traction structure 11 are put together into the biopsy channel 4 of the endoscope 3, and after reaching the distal end of the biopsy channel 4, after reaching the distal end of the biopsy channel 4. Under observation with the eyepiece of the endoscope 3, the clamp arm 24 of the first clamp portion 21 is expanded to simultaneously sandwich one side of the previously separated lesion 5 and one end of the closed traction structure 11. .. At this time, subsequently, the distal end and the proximal end of the clamp body 23 of the first clamp portion 21 are separated, and the distal end of the clamp body of the first clamp portion 21 and the closed traction structure 11 are inside the body. The clamp body 23 is taken out. As shown in FIG. 5, the second clamp portion 22 is inserted into the biopsy channel 4 of the endoscope, reaches the distal end of the biopsy channel 4, and then observed with the eyepiece of the endoscope 3. Below, the clamp arm 26 of the second clamp portion 22 is expanded to sandwich the other end of the closed traction structure 11 and pull it to the other side of the pre-separated lesion 5 with the assistance of an endoscope. Subsequently, the proximal end and the distal end of the clamp body 25 of the second clamp portion 22 are separated, and the distal end of the clamp body of the second clamp portion 22 and the closed traction structure 11 remain in the body. Since the closed traction structure 11 has elasticity, the cut lesion 5 is abducted by the elastic action of the traction portion 1 in the surgical cutting process, and as the surgical cutting operation progresses, the cut lesion 5 becomes larger. It is continuously pulled and gradually separated from the muscle layer 7 until it is completely pulled up, and the separation of the lesion 5 is completely completed. By such a method, the lesion 5 is abducted while being cut, the surgical field of view is widened, and the blood vessels under the mucosa can be found under the direct view of the endoscope, so that bleeding is prevented and the surgical operation is more convenient. Moreover, it became safe and the operation time was shortened. If the lesion 5 is too large, the clamp portion 2 and the closed traction structure may be further increased so that the amputated lesion 5 is completely pulled up in order to pull the lesion 5 in a larger area, or FIG. As shown in the above, the traction portion 1 including the elastic linear structure may be selected so as to increase the range of elastic deformation of the entire traction portion 1.

As shown in FIGS. 4 and 7, when the lesion 5 is relatively large and the space is small, for example, when performing intestinal ESD surgery, one side of the lesion 5 is first incised and as shown in FIG. First, the incised lesion 5 is sandwiched by the clamp arm 24 of the first clamp portion 21, and at this time, the second clamp portion 22 is subsequently sent through the endoscope 3 to receive the eyepiece of the endoscope 3. Under observation with a lens, the clamp arm 26 of the second clamp portion 22 was sandwiched on the mucosal layer 8 on the opposite side of the intestinal lumen, the clamp arm 26 of the second clamp portion 22 was tightly closed, and the cut lesion 5 was formed. Due to the elastic action of the closed traction structure 11, as the surgical cutting operation progresses, it is continuously pulled to maintain the surgical field of view and facilitate the surgical operation.

As shown in FIGS. 9A to 9C, when the wound surface of the lesion 5 is relatively large, with the assistance of the endoscope 3, the clamp arm 24 of the first clamp portion is used first with one side of the wound surface of the lesion 5. After sandwiching one end of the closed traction structure 11, under the assistance of the endoscope 3, the other side of the wound surface of the lesion 5 and the other end of the closed traction structure 11 are subsequently used by using the clamp arm 26 of the second clamp portion. The elasticity of the closed traction structure 11 pulls both sides of the wound surface of the lesion 5 inward, and the wound surface of the lesion 5 shrinks, thereby facilitating further clamping of the wound surface of the lesion 5.

The above is merely a preferred embodiment of the present application, and enables those skilled in the art to understand or realize the invention of the present application. Various modifications and combinations to these embodiments will be apparent to those of skill in the art, and the general principles defined herein will be in other embodiments, provided that they do not deviate from the spirit or scope of the present application. Can be carried out. Therefore, the present application is not limited to these examples presented herein, but should be adapted to the broadest scope that is consistent with the principles and novel features disclosed herein.

1 Tow part 11 Closed tow structure 2 Clamp part 21 First clamp part 22 Second clamp part 23 Clamp body 24 Clamp arm 25 Clamp body 26 Clamp arm 3 Endoscope 4 Biopsy channel 5 Foam 6 Mucosal layer 7 Muscle layer 8 Lamina propria on the opposite side of the lumen

Claims (13)

A traction device that includes a clamp portion and a traction portion, the traction portion includes a closed traction structure made of an elastic material, and the clamp portion includes a clamp body that can pass through a biopsy channel of an endoscope. A traction device comprising a clamp arm capable of sandwiching the closed traction structure. The traction device according to claim 1, wherein the closed traction structure is made of silicone rubber or a thermoplastic elastomer. The traction device according to claim 1, wherein the closed traction structure is one or two or more. The traction device according to claim 3, wherein an elastic structure can be connected between two or more closed traction structures. The traction device according to claim 4, wherein the elastic structure is an elastic linear structure. The traction device according to claim 4, wherein the elastic structure is an elastic ring. The traction device according to any one of claims 1 to 6, wherein the closed traction structure is circular, triangular, rhombic or square. The traction device according to claim 1, wherein the closed traction structure may be elastically deformed by the movement of the clamp body of the clamp portion. A traction ring for a traction device, wherein the traction ring is either one closed traction structure or several closed traction structures are connected and the traction ring is made of an elastic material. Tow ring. The traction ring according to claim 9, wherein an elastic structure is connected between the closed traction structures. The traction ring according to claim 10, wherein the elastic structure is an elastic linear structure. The traction ring according to claim 10, wherein the elastic structure is an elastic ring. The traction ring according to claim 9, wherein the closed traction structure is circular, triangular, rhombic or square.

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